Papular eruption secondary to prolonged application of tetracainelidocaine cream

Sir, a 34-year-old female presented with a history of itchy red lesions on the neck since 2 days. The patient had undergone radiofrequency ablation for dermatosis papulosa nigra and acrochordons 2 days back. The procedure was done after applying TetralidR (tetracainelidocaine) cream under occlusion for 20 minutes. The procedure was uneventful and patient was prescribed fusidic acid ointment for topical application. Subsequently after two days, the patient presented again to the dermatology department with itchy red raised lesions over the treated areas. While eliciting the history, it was found that the patient had applied tetracainelidocaine cream instead of fusidic acid ointment for 2 days. There was no previous history of sensitivity to any topical medications or any other known drug allergies in the past. There was no history suggestive of angioedema or wheals. Cutaneous examination revealed erythema and erythematous papules over the neck (Figure 1). No wheals were noted. The patient refused further investigations like patch testing or skin biopsy.